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Topic: Pricing Strategy (Read 7004 times)

We have not billed for that account in several years. But depending on some variables such as services you would be performing, how billing will be done, will they be entering anything, etc, I would think somewhere in the $7500-9000 per month range would be appropriate.

We have billed for an account similar to this, internal medicine, we did all but verify benefits and appt reminders. And NO CODING. It took 1 employee full time and another employee that could handle some other stuff as well. I agree with Linda, no percentage billing. I prefer a flat monthly fee. I do not like quoting a provider an hourly fee. They do not take all of our expenses into consideration. When you quote a doctor an hourly rate they think they are paying an employee that amount per hour, not a business.

That's what I am planning to do. I will work on this account myself for full time and Will hire a part time employee. Plz don't mind me asking this, but how much flat fee did you charge this particular provider. It will make things more clear for me. A straight forward example..

Thanks in Advance Michelle

We pick up deposits from the doctors office 2-3 times a week. We add up all the patient payments and paper Insurance checks, we also print out a payment report from all the payers we have set up EFT. We turn in our invoice every 2 weeks. It might be easier to track the sum of all payments in your PM software but we have to add up all the payments anyway before we post them.

Don't forget if you hire someone, you will have to deal with taxes etc. It is not up to you who determines whether the person is a subcontractor. The IRS determines that. If you need more info about this, just ask. I am very familiar with this.

If you want to become a certified coder, AHIMA or AAPC. No matter what course you take, it is intense. Be prepared to learn anatomy and physiology and know that it will take you months.I do not recommend AMBA.I will tell you that you can become certified for Certified Healthcare Reimbursement Specialist and Certified HIPAA Information Specialist through the medicalbillingstudycourse.com,. It is online as we update it constantly. It is not on the website yet and you can contact me privately at merry@nebazone.com for more information if you would like. Prices are less but know this is for billing and not coding. I have a different philosophy about the certifications as I have been writing them for over 15 years. I developed them so that you learn what you don't know. It is not a matter of just getting a passing grade and a certificate. My feeling that if a person is serious about this business, they need to know in what areas they are lacking so that they can educate themselves further. BTW, there are no study materials which are outdated so quickly. All the answers are on the Internet..open book. the only place where you can find up to date information today.

We pick up deposits from the doctors office 2-3 times a week. We add up all the patient payments and paper Insurance checks, we also print out a payment report from all the payers we have set up EFT. We turn in our invoice every 2 weeks. It might be easier to track the sum of all payments in your PM software but we have to add up all the payments anyway before we post them.

I had this question in my ind from the very beginning, but I was not sure about how this works. What all can we include in the calculating our fees? Can we include all the payments coming to the providers office, no matter what is the source?

We will definitely include:Payment from Insurance companiesPayment from patients that we called for collections

But can we include:

Co-pays or Deductibles that patient pays during the office visitCapitation payments (becoz we don't have to follow up on them)

I had this question in my ind from the very beginning, but I was not sure about how this works. What all can we include in the calculating our fees? Can we include all the payments coming to the providers office, no matter what is the source?

We will definitely include:Payment from Insurance companiesPayment from patients that we called for collections

But can we include:

Co-pays or Deductibles that patient pays during the office visitCapitation payments (becoz we don't have to follow up on them)

Please advice.. I don't want to sound unjust to the clients

If we are doing insurance only billing we do not include payment such as copays, and patient payments received in the office. But if we are doing full service billing we include all revenue received. We are responsible for tracking all revenue, and making sure it comes in. There is no way to separate revenue that one person collects, or another person, or whether it was in the office or mailed.

If you touch the account you should get paid. Otherwise there would be two sets of books. Up to the provider if he/she wants to do that but the IRS will have a temper tantrum. I am curious why you do not think you ha e ti do work for a capitated acct. When that monthly check cones in, you must check that every person had been included, track withholds etc.

Now can I include everything the doctors collects, except self pay patients. Just confirming, I don't want to be unfair. Thanks Michelle.

This depends on the contract. The consensus is, is that if you plan to do a % of collections it's ALL practice collections including patient payments.. why wouldn't you charge? You touch it, you report it, you bill for it. But again.. HOW this plays out is up to you AND must be spelled out EXACTLY in your contract (another reason I dislike % billing, too many grey areas and loopholes).

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And one more thing, do we charge the same % for capitation payments?? because we don't have to follow up on them.

Again, up to you. With capitation (these will be phasing out over the years as it already has) you are still posting payments, reporting, etc, you should be paid for all services. Again this is why I like the flat fee model, it's based on your time/worth/experience and you get paid for EVERY minute you work. No one can answer these questions w/out knowing what your putting in your contract, as that's extremely important. When you bill on a % you MUST spell everything out so there is NO surprises later. Billing on a flat fee you merely only have to explain the monthly fee and how it's derived from time, work, etc. Most billers I know are still doing % merely because "everyone else is doing it" or they think that's only option provider wants. I've never had a problem talking a provider out of % based billing once I explain the logistics to him. His accountant, his other service providers don't charge % so it's not too hard to explain to him/her on a more reasonable and less scrutinized method of billing.

Here is what I would tell a provider if he wanted to break out collections in office from my % when I did bill %. When you have an office that is going to track ONE set of collections and the billing company another, you now have two sets of books. A BIG FAT NO NO. On the other hand if they let you track those payments they then have ONE nice neat compliant set of books and reports that are true. If the feds come a knocking it won't look good for the billing office to have ONE set and the physicians office another set. And lf they decide to let you post them, who sends out the statements? That leads back to what Merry says, you track it, you touch it you get paid for it. Let's suppose THEY want to track them in the same system, then you have more hands in the cookie jar which also makes a mess. That's why it's best to explain this to the provider so that you are getting paid your percentage on ALL revenue. When you are doing your contract you will spell out all of your services and it will be stated that you will receive $XX for all practice revenues brought it. If you are sending a statement to a patient for $200 and later they send the office $200 you've thrown away money because you billled it, your tracking it! I do understand some billing companies will not charge % on what the office collects but again I refer back to what I said that you now have two sets of books/reports and the practice loses out on a true practice picture of their accounts not to mention the mess it would be if you were to go through an audit.

We charge a percentage. But we have two tiers. Regular percent for non-cash. Half of regular percent for cash. We process all payments, cash and otherwise - so that a patient's account shows all charges, payments, and write-offs. But were we can identify a payment as cash, and we did not have to bill for it or otherwise contact the patient, we assign that payment to a Cash Financial Class. At the end of the month, we can run a report that shows totals for Insurance Payments, Patient Payments in response to Statements sent, and cash payments made in the office.

If we handle it, we get paid for it. But some handling is less than others, and so we charge a lower fee for that.

Re. double bookkeeping - some clients sell things from their office, like vitamins, etc. Those sales have nothing to do with the procedures performed on the patient, and so we have no need or desire to track those in-office payments. The office runs their own books on those misc. sales and payments.